Материалы и методы

neurosurgery

Нейрохирургия

Russian journal of neurosurgery

1683-32952587-7569

Издательский дом "МедИНК"

10.17650/1683-3295-2018-20-3-91-103

neurosurgery-607

Research Article

ОБЗОРЫ ЛИТЕРАТУРЫ

LITERATURE REVIEW

Сочетание дегенеративного стеноза позвоночного канала с деформацией позвоночника на поясничном уровне. Обзор литературы

Combination of degenerative lumbar spinal stenosis and spinal deformity. Literature review

https://orcid.org/0000-0002-1755-1752

Никитин

А. С.

Nikitin

A. S.

https://orcid.org/0000-0003-3515-8329

Гринь

А. А.

Grin

A. A.

Андрей Анатольевич Гринь

127473 Москва, ул. Делегатская, 20, стр. 1

aagreen@yandex.ru

ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава РоссииРоссияA.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of RussiaRussian Federation

ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России; ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского Департамента здравоохранения г. Москвы»РоссияA.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia; N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare DepartmentRussian Federation

2018

19092018

20391103

2018

Никитин А.С., Гринь А.А.

Nikitin A.S., Grin A.A.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.therjn.com/jour/article/view/607

Цель исследования – провести анализ данных литературы, посвященной вопросам деформации позвоночника у больных с дегенеративным стенозом позвоночного канала на поясничном уровне.

Материалы и методы

Материалы и методы. Изучены 90 научных источников, опубликованных в 1980–2017 гг.

Результаты

Результаты. Описаны параметры, используемые для оценки деформации позвоночника, рассмотрена их роль в прогнозировании течения дегенеративной болезни позвоночника. Приведены результаты современных исследований влияния деформации позвоночника на исход хирургического лечения больных с дегенеративным стенозом позвоночного канала на поясничном уровне. Определены факторы риска прогрессирования сколиоза: клиновидная форма межпозвонкового диска во фронтальной плоскости, низкое прохождение межгребневой линии, латеральный спондилолистез, маленький размер тела позвонка L , ротация позвонков, угол Кобба более 20°, нарушение сагиттального баланса.

Заключение

Заключение. При отсутствии факторов риска прогрессирования сколиоза и наличии только корешковой симптоматики (без выраженной боли в поясничной области) у пациентов с дегенеративным стенозом позвоночного канала на поясничном уровне и деформацией позвоночника рекомендовано выполнение декомпрессивных вмешательств с сохранением дугоотростчатых суставов. При отсутствии факторов риска прогрессирования сколиоза, наличии корешковой симптоматики и боли в поясничной области целесообразно сочетать декомпрессию с короткой фиксацией. При наличии факторов риска декомпрессию необходимо дополнить длинной фиксацией, превышающей длину дуги сколиоза.

The study objective is to analyze currently available publications on spinal deformity in patients with degenerative lumbar spinal stenosis.

Materials and methods

Materials and methods. We analyzed 90 manuscripts published between 1980 and 2017.

Results

Results. We describe the parameters used to assess spinal deformity and evaluate their role for predicting the course of degenerative spinal disease. We provide the results of latest studies assessing the impact of spinal deformity on the outcome of surgical treatment in patients with degenerative lumbar spinal stenosis. We identified the following risk factors for scoliosis progression: wedge-shaped intervertebral disc in the frontal projection, low middle sacral axis, lateral spondylolisthesis, small L vertebral body, vertebral rotation, Cobb angle >20°, and sagittal imbalance.

Conclusion

Conclusion. We recommend decompressive interventions with facet joint preservation in patients with spinal deformity and degenerative lumbar spinal stenosis with no risk factors for scoliosis progression and radicular symptoms only (without pronounced low back pain). In patients with no risk factors for scoliosis progression, radicular symptoms, and low back pain, it is advisable to combine decompression with short fixation. For individuals at risk of scoliosis progression, we recommend supplementing decompression with long fixation exceeding scoliosis curve.

дегенеративный стеноз позвоночного каналадеформация позвоночникасколиозфакторы рискадекомпрессияфиксацияболевой синдром

degenerative spinal stenosisspinal deformityscoliosisrisk factorsdecompressionfixationpain syndrome

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The authors declare that there are no conflicts of interest present.